BILL OF SUPPLY

Name : Mr.NEERAJ JAIN Visit No : AKV23045909

Age/Gender : 46 Y / Male Invoice No : SI23-24DL0043268
Contact No : 9810361190 Visit/Reg Date : 29-Apr-2023 07:46AM
Address : ashok vihar ,,Delhi (North) Refered By : Dr.PRITAM GUPTA
UHID : UAKV.0000000491 Center : BTC ASHOK VIHAR
Home Collection : No Center Ph. No : 9654881155
GSTIN : 07AACCN6471F1ZG
HSN/SAC Code : 999316

# Service Code Service Name SIN No. MRP Rate Total

1 PL0006 Hb A1c ED00603382 540 270 270

2 PL0011 C-Reactive Protein CL01195630 498 249 249

3 PL0049 Testosterone CL01195630 698 349 349

4 PL0051 Insulin [Fasting] CL01195630 880 440 440

5 PL0075 Magnesium CL01195630 598 299 299

6 PL0110 Cortisol (Morning) CL01195630 698 349 349

Preventive Health Checkup - Basic Care (CBC,Glucose Fasting,Lipid 1998 999 999
7 PK0002
Profile,Liver Function Test,Kidney Function Test,ESR)

Settlement Payment Receipt No Mode Amount Bill Amount : 2955

Settlement 29-04-2023 RAKV/23-24/00000460 Cash 2955 Total Paid Amount : 2955

Received with thanks : Two Thousand Nine Hundred And Fifty Five Only Authorized Signature :

For accessing online reports log on to www.houseofdiagnostics.com; Lab ID: AKV23045909; password : 9810361190;
1. Reports are available online for 30 days. Thereafter report are archived for upto 3 years after the test.
2. Services provided hereunder are healthcare services which are exempt from GST under serial no. 74 of notification 12/2017 - Central Tax(Rate).
3. Images for all modalities film/CD once issued will be re-issued upon an additional charge as per rate list. Images are stored in databank for upto a period of 30 days
only. Thereafter the House Of Diagnostics dose not hold any responsibility / liability of issuance of any such Images on film/CD.
4. Films and Images are normally provided as hard copies. Incase images are needed on a CD, charges will be extra, at applicable rates.
5. Test Group with SIN No. beginning with OS are outsourced and not performed at the House of Diagnostics laboratory.
6. A Whole Body PETCT Scan is done for Head to Mid Thigh region.
7. Call Center: 9089089089; Timing: 7:00 AM to 10:00 PM.
8. No refunds will be made once test is performed.
9. Advance taken for PET CT scan is refundable as per below mentioned point 10, only if cancellation request is made before 8 PM, a day before the test scheduled
date. Any reason for cancellation. Thereafter shall result in forfeiture of Rs. 5000/-.
10. Refund of any test on account of test not done, will take 10 days after completing needful paperwork formalities and will be by NEFT only. Please provide
complete Account details for the NEFT. HOD will not be liable incase wrong bank A/c details are provided. All refunds will be subject to deduction of Rs. 50/- or 2%
of the amount, whichever is higher.
11. Refund or Adjustment of any advance amount paid against any test must be utilized within 90 days of making payment/advance. All such amounts will stand
forfeited after 90 days of making any advance payment.
12. I, hereby give my consent for the above billed tests to be performed on me/my patient.
13. ICMR Registration Number for House Of Diagnostics is HDHPLDD.

Printed By: UTTAM RAJ CHAUHAN (RJN) Created By: UTTAM RAJ CHAUHAN (RJN) 29-Apr-2023 07:46 AM Page 1 of 1